Realidade virtual na reabilitação de doentes com acidente vascular cerebral: uma scoping review / Virtual reality in the rehabilitation of stroke patients: a scoping review

Introdução: O AVC constitui-se como um dos principais desafios de saúde pública a nível mundial acarretando um elevado impacto em diferentes níveis. A intervenção do Enfermeiro Especialista em Enfermagem de Reabilitação assume um papel preponderante nos cuidados ao doente após AVC. A evolução da tecnologia, os avanços da ciência e da terapêutica no tratamento do AVC, tem vindo a evidenciar-se com repercussões na melhoria da qualidade de vida dos doentes. Com esta evolução surge a Realidade Virtual como um recurso terapêutico com a capacidade de gerar ambientes flexíveis e adequados no processo de recuperação. Objetivo: Mapear o efeito da Realidade Virtual na Reabilitação de Doentes com Acidente Vascular Cerebral. Metodologia: Estudo de revisão, scoping review, sustentada na metodologia de Joanna Briggs Institute. Definindo a População (P), Conceito (C) e Contexto (C) em que P: doentes adultos com AVC, independentemente do género, (C) realidade virtual e (C) reabilitação motora, cognitiva e/ou sensorial. Formulada a questão de revisão: "Qual o Efeito da Realidade Virtual na Reabilitação de Doentes com AVC?". Realizada pesquisa nas seguintes bases de dados: PubMed, CINAHL complete, EBSCO, SciELO e RCAAP com espaço temporal de publicação de janeiro de 2012 a dezembro de 2022. Resultados: Foram incluídos trinta e quatro estudos com diferentes metodologias e natureza de estudo. A análise dos estudos revelou que a integração da realidade virtual conduziu a ganhos nos domínios da reabilitação motora, cognitiva e sensorial com influência na qualidade de vida, podendo ser considerada como um método eficaz e um importante coadjuvante dos programas de reabilitação convencional. Conclusões: Evidenciada a utilidade do uso da realidade virtual no processo de reabilitação, nomeadamente nos programas específicos concebidos e implementados pelo Enfermeiro Especialista em Enfermagem de Reabilitação. Podemos então considerar que o efeito da realidade virtual na reabilitação de doentes com AVC parece ser positivo.

Introduction: Stroke is one of the main public health challenges worldwide, causing a high impact at different levels. The intervention of the Specialist Nurse in Rehabilitation Nursing plays a preponderant role in the care of patients after a stroke. The evolution of technology, advances in science and therapy in the treatment of stroke, have been evident with repercussions in improving the life quality of patients. With this evolution Virtual Reality emerges as a therapeutic resource with the ability to generate flexible and appropriate environments in the recovery process. Objective: Map the effect of Virtual Reality in the Rehabilitation of Patients with Stroke. Methodology: Review study, a scoping review, based on the Joanna Briggs Institute methodology. Defining the Population (P), Concept (C) and Context (C) in which (P): adult stroke patients, regardless of gender, (C) virtual reality and (C) motor, cognitive and/or sensory rehabilitation. The review question was formulated: "What is the Effect of Virtual Reality on the Rehabilitation of Stroke Patients?". Research was carried out in the following databases: PubMed, CINAHL complete, EBSCO, SciELO and RCAAP with publication timeframe from January 2012 to December 2022. Results: Thirty-four studies with different methodologies and study nature were included. The analysis of the studies revealed that the integration of virtual reality led to gains in the areas of motor, cognitive and sensory rehabilitation with an influence on quality of life and can be considered as an effective method and an important adjunct to conventional rehabilitation programs. Conclusions: The usefulness of using virtual reality in the rehabilitation process was highlighted, particularly in specific programs designed and implemented by Specialist Nurse in Rehabilitation Nursing. We can thus consider that the effect of virtual reality on the rehabilitation of stroke patients appears to be positive.

Scientometric Analysis of the World Scientific Production on Augmented and Virtual Reality in Dental Education.

AIM: The aim of this study was to perform a comprehensive bibliometric analysis of virtual reality (VR) and augmented reality (AR) applications in dental education. MATERIALS AND METHODS: A cross-sectional research was carried out using a bibliometric methodology. This process entailed the assessment of metadata from scientific publications that are catalogued in the Scopus database, covering the period from January 2018 to August 2023. A variety of indicators were utilized to scrutinize scientific production and dissemination within the academic community. These encompassed elements such as the author, the publication itself, the number of citations, institutional and collaborative affiliations, geographical location, journal quartile ranking, h-index, Source Normalized Impact per Paper (SNIP), Field-Weighted Citation Impact (FWCI), SCImago Journal Rank (SJR), and the CiteScore. RESULTS: Several institutions from different countries and their academic output were found. Beihang University stands out with 16 scholarly articles, followed by Stanford University with 16 articles and 170 citations. The Q1 quartile has experienced a steady increase, reaching 87 scientific articles. The top 10 authors in scientific production on augmented and VR in dentistry include Joe Amal Cecil, Avinash Gupta, and Miguel A Pirela-Cruz. In terms of co-authorship by country, the United States, Germany, and China are the most predominant in the clusters represented. However, other clusters also have a significant presence. By analyzing the explored trends and themes of keyword co-occurrence, four main clusters were identified. The yellow cluster contained the largest amount of research with the keyword "virtual reality." In addition, the blue cluster was found to be best related to the green "simulation," purple "virtual reality (VR)," and light blue "human-centered computing" clusters. CONCLUSION: This study evidenced the availability and quality of the data used for the analysis. Future studies could consider the use of VR systems with integrated eye tracking and compare their effect in dentistry during dental procedures. CLINICAL SIGNIFICANCE: The clinical importance of this study lies in its potential to improve dental education. The VR and AR can provide dental students with immersive, hands-on learning experiences, which can enhance their understanding and clinical skills. Furthermore, the translational value of this study extends beyond dental education. The insights gained from this research could be applicable to other fields of medical education where hands-on training is crucial. Thus, the findings of this study have the potential to influence the broader landscape of medical education, ultimately leading to improved healthcare outcomes. How to cite this article: Alvitez-Temoche D, Silva H, Aguila ED, et al. Scientometric Analysis of the World Scientific Production on Augmented and Virtual Reality in Dental Education. J Contemp Dent Pract 2024;25(4):358-364.

Sex-related differences in young binge drinkers on the neurophysiological response to stress in virtual reality.

Background: Stress is one of the main environmental factors involved in the onset of different psychopathologies. In youth, stressful life events can trigger inappropriate and health-damaging behaviors, such as binge drinking. This behavior, in turn, can lead to long-lasting changes in the neurophysiological response to stress and the development of psychological disorders late in life, e.g., alcohol use disorder. Our aim was to analyze the pattern of neurophysiological responses triggered with the exposition to a stressful virtual environment in young binge drinkers. Methods: AUDIT-3 (third question from the full AUDIT) was used to detect binge drinking (BD) in our young sample (age 18-25 years). According to the score, participants were divided into control (CO) and BD group. Next, a standardized virtual reality (VR) scenario (Richie's Plank) was used for triggering the stress response while measuring the following neurophysiological variables: brain electrical activity by electroencephalogram (EEG) and cortisol levels through saliva samples both measurements registered before and after the stressful situation. Besides, heart rate (HR) with a pulsometer and electrodermal response (EDA) through electrodes placed on fingers were analyzed before, during and after the VR task. Results: Regarding the behavior assessed during the VR task, BD group spent significantly less amount of time walking forward the table and a tendency toward more time walking backwards. There was no statistically significant difference between the BD and the CO group regarding time looking down, but when we controlled the variable sex, the BD women group displayed higher amount of time looking down than the rest of the groups. Neurophysiological measurements revealed that there was not any statistically significant difference between groups in any of the EEG registered measures, EDA response and cortisol levels. Sex-related differences were found in HR response to VR scenario, in which BD women displayed the highest peak of response to the stressor. Also, the change in heartbeat was higher in BD women than men. Conclusion: Unveiling the neurophysiological alterations associated with BD can help us to prevent and detect early onset of alcohol use disorder. Also, from our data we conclude that participants' sex can modulate some stress responses, especially when unhealthy behaviors such as BD are present. Nevertheless, the moment of registration of the neurophysiological variables respect to the stressor seems to be a crucial variable.

Optimizing placebo and minimizing nocebo effects through communication: e-learning and virtual reality training development.

BACKGROUND: The effects of many treatments in healthcare are determined by factors other than the treatment itself. Patients' expectations and the relationship with their healthcare provider can significantly affect treatment outcomes and thereby play a major role in eliciting placebo and nocebo effects. We aim to develop and evaluate an innovative communication training, consisting of an e-learning and virtual reality (VR) training, for healthcare providers across all disciplines, to optimize placebo and minimize nocebo effects through healthcare provider-patient communication. The current paper describes the development, mid-term evaluation, optimization, and final evaluation of the communication training, conducted in The Netherlands. METHODS: The development of both the e-learning and the VR training consisted of four phases: 1) content and technical development, 2) mid-term evaluation by healthcare providers and placebo/communication researchers, 3) optimization of the training, and 4) final evaluation by healthcare providers. To ensure the success, applicability, authenticity, and user-friendliness of the communication training, there was ongoing structural collaboration with healthcare providers as future end users, experts in the field of placebo/communication research, and educational experts in all phases. RESULTS: Placebo/communication researchers and healthcare providers evaluated the e-learning positively (overall 7.9 on 0-10 scale) and the content was perceived as useful, accessible, and interesting. The VR training was assessed with an overall 6.9 (0-10 scale) and was evaluated as user-friendly and a safe method for practicing communication skills. Although there were some concerns regarding the authenticity of the VR training (i.e. to what extent the virtual patient reacts like a real patient), placebo and communication researchers, as well as healthcare providers, recognized the significant potential of the VR training for the future. CONCLUSIONS: We have developed an innovative and user-friendly communication training, consisting of an e-learning and VR training (2D and 3D), that can be used to teach healthcare providers how to optimize placebo effects and minimize nocebo effects through healthcare provider-patient communication. Future studies can work on improved authenticity, translate the training into other languages and cultures, expand with additional VR cases, and measure the expected effects on providers communication skills and subsequently patient outcomes.

Deep learning-based stress detection for daily life use using single-channel EEG and GSR in a virtual reality interview paradigm.

This research aims to establish a practical stress detection framework by integrating physiological indicators and deep learning techniques. Utilizing a virtual reality (VR) interview paradigm mirroring real-world scenarios, our focus is on classifying stress states through accessible single-channel electroencephalogram (EEG) and galvanic skin response (GSR) data. Thirty participants underwent stress-inducing VR interviews, with biosignals recorded for deep learning models. Five convolutional neural network (CNN) architectures and one Vision Transformer model, including a multiple-column structure combining EEG and GSR features, showed heightened predictive capabilities and an enhanced area under the receiver operating characteristic curve (AUROC) in stress prediction compared to single-column models. Our experimental protocol effectively elicited stress responses, observed through fluctuations in stress visual analogue scale (VAS), EEG, and GSR metrics. In the single-column architecture, ResNet-152 excelled with a GSR AUROC of 0.944 (±0.027), while the Vision Transformer performed well in EEG, achieving peak AUROC values of 0.886 (±0.069) respectively. Notably, the multiple-column structure, based on ResNet-50, achieved the highest AUROC value of 0.954 (±0.018) in stress classification. Through VR-based simulated interviews, our study induced social stress responses, leading to significant modifications in GSR and EEG measurements. Deep learning models precisely classified stress levels, with the multiple-column strategy demonstrating superiority. Additionally, discreetly placing single-channel EEG measurements behind the ear enhances the convenience and accuracy of stress detection in everyday situations.

The impact of simulation-based training in medical education: A review.

Simulation-based training (SBT) has emerged as a transformative approach in medical education, significantly enhancing healthcare professionals' learning experience and clinical competency. This article explores the impact of SBT, tracing its historical development and examining the various types of simulations utilized today, including high-fidelity mannequins, virtual reality environments, standardized patients, and hybrid simulations. These methods offer a safe and controlled environment for students to practice and hone technical and non-technical skills, ultimately improving patient safety and clinical outcomes. The benefits of SBT are manifold, including enhanced skill acquisition, error reduction, and the opportunity for repeated practice without risk to actual patients. Immediate feedback and structured debriefing further solidify learning, making Simulation an invaluable tool in medical education. However, the implementation of SBT is challenging. It requires substantial financial investment, specialized equipment, and trained faculty. Additionally, there are concerns about the realism of simulations and the transferability of skills to real-world clinical settings. Despite these challenges, numerous case studies and empirical research underscore the effectiveness of SBT compared to traditional methods. Looking ahead, advancements in technology, such as artificial intelligence and improved virtual reality applications, promise to enhance the efficacy and accessibility of simulation training. The integration of Simulation with other training modalities and its adoption in diverse global contexts highlight its potential to revolutionize medical education worldwide. This article affirms the crucial role of SBT in preparing the next generation of healthcare professionals and its ongoing evolution driven by technological innovations.

The effect of balance training using touch controller-based fully immersive virtual reality devices on balance and walking ability in patients with stroke: A pilot randomized controlled trial.

BACKGROUND: Fully immersive virtual reality (FIVR) removes information from the real world and replaces it with computer-generated data, creating the impression of being in a genuine virtual world. OBJECTIVE: To evaluate the effects of balance training using touch controller-based FIVR devices on balance and walking abilities in patients with stroke. METHODS: The participants were randomly categorized into the FIVR group (n = 18) and control group (n = 18). The control group received conventional therapy for 5 sessions, 30 minutes per week, for 5 weeks. The FIVR group practiced additional touch controller-based FIVR balance training for 3 sessions of 30 minutes per week for 5 weeks and changes in balance and walking ability were measured for both groups. RESULTS: Touch controller-based FIVR balance training significantly improved the Berg Balance Scale (BBS) and, timed up-and-go (TUG) test results (P < .01). There was also significant improvement in gait abilities, including gait velocity, step length of the affected side, stride length, and single limb support of the affected side (P < .01). CONCLUSION: Touch controller-based FIVR balance training improved balance and gait in patients with stroke. These results indicate that touch controller-based FIVR balance training is feasible and suitable for patients with stroke, providing a promising avenue for rehabilitation.

Three-dimensional exergaming conjunction with vestibular rehabilitation in individuals with Benign Paroxysmal Positional Vertigo: A feasibility randomized controlled study.

BACKGROUND: To examine the effectiveness of 3D (dimensional)-vestibular rehabilitation therapy (VRT) on gait, balance problems, processing time speed and subjective complaints in patients with Benign Paroxysmal Positional Vertigo (BPPV) compared to a control group (CG). This study aimed to test the feasibility of virtual reality-based 3D exergaming conjunction with vestibular rehabilitation. METHODS: Twenty-two patients with BPPV (negative DixHallpike/Roll test results, existing dizziness/balance complaints) were randomly allocated to the study group (SG, n:11 3D-VRT) or Control group (CG n:11, no exercise-rehabilitation) for 8 week. The SG performed 3D-VRT for 45 to 50 min/d, 3 times/wk, and the CG did receive only Canalith Repositioning Maneuver (CRM). CRM was applied in both groups before the study. Outcome measures included 10-Meter-Walk-Test (10-MWT) (with/without head turns), Dynamic Gait Index (DGI), Choice-Stepping-Reaction-Time-ped (CSRT-MAT), Fullerton Advanced Balance Scale (FAB), and Visual Analog Scale (VAS). RESULTS: The SG showed significantly improvement in 10-MWT without (p5 = 0.00,η2 = 0.49), with horizontal (p5 = 0.00,η2 = 0.57),vertical (p5 = 0.01,η2 = 0.48) head turns, DGI (p5 = 0.00,η2 = 0.74), CSRT-MAT, FAB (p5 = 0.00,η2 = 0.78) and VAS-dizziness (p5 = 0.00,η2 = 0.65), VAS-balance problem (p5 = 0.00,η2 = 0.43), VAS-fear of falling (p5 = 0.00,η2 = 0.42) compared to the CG. CONCLUSION: The 3D-VRT were effective in improving gait, balance, processing speed and resolving the subjective complaints in BPPV. The 3D-VRT method is feasible for patients who suffer from residual dizziness or balance complaints after CRM. Furthermore, the 3D-VRT is more accessible and less expensive than other virtual reality applications, which may facilitate further research or clinical use.

Effects of virtual reality-based robot therapy combined with task-oriented therapy on upper limb function and cerebral cortex activation in patients with stroke.

BACKGROUND: This study aimed to investigate the effects of virtual reality (VR)-based robot therapy combined with task-oriented therapy on cerebral cortex activation and upper limb function in patients with stroke. METHODS: This study included 46 patients with hemiplegia within 1 year of stroke onset. Patients were divided into an experimental group (n = 23) and a control group (n = 23) using a computer randomization program. The experimental group received VR-based robot and task-oriented therapies, whereas the control group received only task-oriented therapy. All participants received interventions for 40 minutes per session, 5 times a week, for 8 weeks. For the pre- and post-evaluation of all participants, the Fugl-Meyer Assessment for the upper extremity, manual function test, motor activity log, and Jebsen-Taylor Hand Function Test were used to evaluate changes in upper limb function and motor-evoked potential amplitudes were measured to compare cerebral cortex activation. RESULTS: In comparison to the control group, experimental group demonstrated an improvement in the function of the upper limb (P < .01) and activation of the cerebral cortex (P < .01). CONCLUSION: The combined intervention of VR-based robot and task-oriented therapies is valuable for improving upper limb function and cerebral cortex activation in patients with stroke.

The future of telerehabilitation: embracing virtual reality and augmented reality innovations.

The integration of virtual reality (VR) and augmented reality (AR) into the telerehabilitation initiates a major change in the healthcare practice particularly in neurological and also orthopedic rehabilitation. This essay reflects the potential of the VR and AR in their capacity to create immersive, interactive environments that facilitate the recovery. The recent developments have illustrated the ability to enhance the patient engagement and outcomes, especially in tackling the complex motor and cognitive rehabilitation needs. The combination of artificial intelligence (AI) with VR and AR will bring the rehabilitation to the next level by enabling adaptive and responsive treatment programs provided through real-time feedback and predictive analytics. Nevertheless, the issues such as availability, cost, and digital gap among many others present huge obstacles to the mass adoption. This essay provides a very thorough review of the existing level of virtual reality and augmented reality in rehabilitation and examines the many potential gains, drawbacks, and future directions from a different perspective.

The Influence of Billboard-Based Tobacco Prevention Posters on Memorization, Attitudes, and Craving: Immersive Virtual Reality Study.

BACKGROUND: Health prevention campaigns often face challenges in reaching their target audience and achieving the desired impact on health behaviors. These campaigns, particularly those aimed at reducing tobacco use, require rigorous evaluation methods to assess their effectiveness. OBJECTIVE: This study aims to use immersive virtual reality (iVR) to systematically evaluate recall, attitudinal, and craving responses to antitobacco prevention messages when presented in a realistic virtual environment, thereby exploring the potential of iVR as a novel tool to improve the effectiveness of public health campaigns. METHODS: A total of 121 undergraduate students (mean age 19.6, SD 3.7 years), mostly female (n=99, 82.5%), were invited to take a guided walk in the virtual environment, where they were randomly exposed to a different ratio of prevention and general advertising posters (80/20 or 20/80) depending on the experimental condition. Participants' gaze was tracked throughout the procedure, and outcomes were assessed after the iVR exposure. RESULTS: Incidental exposure to antitobacco prevention and general advertising posters did not significantly alter attitudes toward tobacco. Memorization of prevention posters was unexpectedly better in the condition where advertising was more frequent (ß=-6.15; P<.001), and high contrast between poster types led to a better memorization of the less frequent type. Despite a nonsignificant trend, directing attention to prevention posters slightly improved their memorization (ß=.02; P=.07). In addition, the duration of exposure to prevention posters relative to advertisements negatively affected memorization of advertising posters (ß=-2.30; P=.01). CONCLUSIONS: Although this study did not find significant changes in attitudes toward tobacco after exposure to prevention campaigns using iVR, the technology does show promise as an evaluation tool. To fully evaluate the use of iVR in public health prevention strategies, future research should examine different types of content, longer exposure durations, and different contexts. TRIAL REGISTRATION: Open Science Framework E3YK7; https://osf.io/e3yk7.

IAVRS-International Affective Virtual Reality System: Psychometric Assessment of 360° Images by Using Psychophysiological Data.

Virtual Reality is an effective technique for eliciting emotions. It provides immersive and ecologically valid emotional experiences while maintaining experimental control. Recently, novel VR forms like 360° videos have been used successfully for emotion elicitation. Some preliminary databases of 360° videos for emotion elicitation have been proposed, but they tapped mainly into an emotional dimensional approach and did not include a concurrent physiological assessment of an emotional profile. This study expands on these databases by combining dimensional and discrete approaches to validate a new set of 360° emotion-inducing images. Twenty-six participants viewed 46 immersive images, and their emotional reactions were measured using self-reporting, psychophysiological signals, and eye tracking. The IAVRS database can successfully elicit a wide range of emotional responses, including both positive and negative valence, as well as different levels of arousal. Results reveal an important correspondence between the discrete and dimensional models of emotions. Furthermore, the images that exhibit convergence between the dimensional and discrete emotional models are particularly impactful regarding arousal and valence values. The IAVRS database provides insights into potential relationships between physiological parameters and emotional responses. This preliminary investigation highlights the complexity of emotional elicitation processes and their physiological correlates, suggesting the need for further research to deepen our understanding.

Predicting the Arousal and Valence Values of Emotional States Using Learned, Predesigned, and Deep Visual Features.

The cognitive state of a person can be categorized using the circumplex model of emotional states, a continuous model of two dimensions: arousal and valence. The purpose of this research is to select a machine learning model(s) to be integrated into a virtual reality (VR) system that runs cognitive remediation exercises for people with mental health disorders. As such, the prediction of emotional states is essential to customize treatments for those individuals. We exploit the Remote Collaborative and Affective Interactions (RECOLA) database to predict arousal and valence values using machine learning techniques. RECOLA includes audio, video, and physiological recordings of interactions between human participants. To allow learners to focus on the most relevant data, features are extracted from raw data. Such features can be predesigned, learned, or extracted implicitly using deep learners. Our previous work on video recordings focused on predesigned and learned visual features. In this paper, we extend our work onto deep visual features. Our deep visual features are extracted using the MobileNet-v2 convolutional neural network (CNN) that we previously trained on RECOLA's video frames of full/half faces. As the final purpose of our work is to integrate our solution into a practical VR application using head-mounted displays, we experimented with half faces as a proof of concept. The extracted deep features were then used to predict arousal and valence values via optimizable ensemble regression. We also fused the extracted visual features with the predesigned visual features and predicted arousal and valence values using the combined feature set. In an attempt to enhance our prediction performance, we further fused the predictions of the optimizable ensemble model with the predictions of the MobileNet-v2 model. After decision fusion, we achieved a root mean squared error (RMSE) of 0.1140, a Pearson's correlation coefficient (PCC) of 0.8000, and a concordance correlation coefficient (CCC) of 0.7868 on arousal predictions. We achieved an RMSE of 0.0790, a PCC of 0.7904, and a CCC of 0.7645 on valence predictions.

[Application of virtual simulation technology in epidemiology education: a systematic review].

Objective: To systematically review the progress, advantages, disadvantages, precautions and future trends of virtual simulation technology used in epidemiology teaching. Methods: A systematical literature retrieval was conducted by using PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Data and VIP Paper Check System with key words of epidemiology, teaching and virtual simulation, and the literatures included were screened and classified with narrative integration method. Chinese virtual simulation teaching platforms were used to select the literatures about existing epidemiology virtual simulation teaching projects for integration and analysis. Results: A total of 22 articles were included (7 in Chinese and 15 in English), most of which were teaching projects for students majoring in Public Health. We also found 24 national first-class courses and 21 provincial first-class courses in virtual simulation of epidemiology in China. The application of virtual simulation technology in epidemiology education is still in its infancy, and the interaction degree is mostly moderate. It is mainly used in three scenarios: improving the visualization degree of complex concepts and structures, training the operational skills through low-risk and low-cost virtual environment, serving as an effective supplement to the teaching of epidemiological field investigation and response to public health emergencies. In terms of effect, it is conducive to students' understanding of epidemiology related phenomena and principles, and has the advantages of breaking through time and space constraints, reducing teaching costs and risks, improving students' attention and satisfaction and so on. However, it also faces the lack of foundation in the initial stage, and some students have problems such as psychological and physiological discomfort. In the future, we need to optimize the development process, program design and so on. At the same time, we should conduct more in-depth research on cost calculation, effect evaluation and curriculum integration. Conclusions: The application of virtual simulation technology in epidemiology education is an important part of training high-level applied public health talents. We encourage to actively carry out virtual simulation teaching in epidemiology, and train public health talents with Chinese characteristics.

Where was this thing again? Evaluating methods to indicate remembered object positions in virtual reality.

A current focus in sensorimotor research is the study of human perception and action in increasingly naturalistic tasks and visual environments. This is further enabled by the recent commercial success of virtual reality (VR) technology, which allows for highly realistic but well-controlled three-dimensional (3D) scenes. VR enables a multitude of different ways to interact with virtual objects, but only rarely are such interaction techniques evaluated and compared before being selected for a sensorimotor experiment. Here, we compare different response techniques for a memory-guided action task, in which participants indicated the position of a previously seen 3D object in a VR scene: pointing, using a virtual laser pointer of short or unlimited length, and placing, either the target object itself or a generic reference cube. Response techniques differed in availability of 3D object cues and requirement to physically move to the remembered object position by walking. Object placement was the most accurate but slowest due to repeated repositioning. When placing objects, participants tended to match the original object's orientation. In contrast, the laser pointer was fastest but least accurate, with the short pointer showing a good speed-accuracy compromise. Our findings can help researchers in selecting appropriate methods when studying naturalistic visuomotor behavior in virtual environments.

Reviewing the current state of virtual reality integration in medical education - a scoping review.

BACKGROUND: In medical education, new technologies like Virtual Reality (VR) are increasingly integrated to enhance digital learning. Originally used to train surgical procedures, now use cases also cover emergency scenarios and non-technical skills like clinical decision-making. This scoping review aims to provide an overview of VR in medical education, including requirements, advantages, disadvantages, as well as evaluation methods and respective study results to establish a foundation for future VR integration into medical curricula. METHODS: This review follows the updated JBI methodology for scoping reviews and adheres to the respective PRISMA extension. We included reviews in English or German language from 2012 to March 2022 that examine the use of VR in education for medical and nursing students, registered nurses, and qualified physicians. Data extraction focused on medical specialties, subjects, curricula, technical/didactic requirements, evaluation methods and study outcomes as well as advantages and disadvantages of VR. RESULTS: A total of 763 records were identified. After eligibility assessment, 69 studies were included. Nearly half of them were published between 2021 and 2022, predominantly from high-income countries. Most reviews focused on surgical training in laparoscopic and minimally invasive procedures (43.5%) and included studies with qualified physicians as participants (43.5%). Technical, didactic and organisational requirements were highlighted and evaluations covering performance time and quality, skills acquisition and validity, often showed positive outcomes. Accessibility, repeatability, cost-effectiveness, and improved skill development were reported as advantages, while financial challenges, technical limitations, lack of scientific evidence, and potential user discomfort were cited as disadvantages. DISCUSSION: Despite a high potential of VR in medical education, there are mandatory requirements for its integration into medical curricula addressing challenges related to finances, technical limitations, and didactic aspects. The reported lack of standardised and validated guidelines for evaluating VR training must be overcome to enable high-quality evidence for VR usage in medical education. Interdisciplinary teams of software developers, AI experts, designers, medical didactics experts and end users are required to design useful VR courses. Technical issues and compromised realism can be mitigated by further technological advancements.

Experiences and perceptions of palliative care patients receiving virtual reality therapy: a meta-synthesis of qualitative studies.

BACKGROUND: The combination of virtual reality (VR) and palliative care potentially represents a new opportunity for palliative care. Many previous studies have evaluated the application of VR therapy to patients with advanced disease receiving palliative care. However, patient-perspective reviews to comprehensively understand the actual experiences and feelings of patients and provide practical guidance for designing future studies are currently lacking. This review of qualitative evidence aimed to explore the experiences and perceptions of patients receiving VR therapy in palliative care. METHODS: This study was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement guidelines. Ten databases, namely, PubMed, Web of Science, EBSCO, OVID MEDLINE, Scopus, John Wiley, ProQuest, CNKI, WANFANG DATA, and SinoMed, were searched, and qualitative and mixed studies from the establishment of each database to June 30, 2023 were included. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of the included studies. The data included in the literature were analyzed and integrated by "thematic synthesis" to formalize the identification and development of themes. RESULTS: The nine selected studies altogether included 156 participants from seven hospice care facilities of different types and two oncology centers. Three key themes were identified: experiences of palliative care patients in VR therapy, the perceived value that palliative care patients gain in VR therapy, and perspectives of palliative care patients toward using VR therapy. CONCLUSIONS: The patients' feedback covered discomfort caused by VR devices, good sense of experiences, and situations that affected the interactive experience. Some patients were unable to tolerate VR therapy or reported newer forms of discomfort. The findings indicated that VR therapy may be an effective approach to relieve patients' physical and psychological pain and help them gain self-awareness. Moreover, patients showed a preference for personalized VR therapy.

Effectiveness of Virtual Reality in the Management of Anxiety and Pain Peri-Treatment for Breast Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND: Breast cancer is the second most common cancer in humans. Its therapy procedures such as breast biopsy can cause anxiety and persistent pain in patients. Virtual reality (VR) has been applied to promote comfort in various populations. However, the effectiveness of VR in relieving pain and anxiety in patients undergoing breast cancer treatment is unclear. PURPOSE: This study was designed to examine the effect of VR on anxiety and pain in people undergoing treatment for breast cancer. METHODS: PubMed, Cochrane, Embase, Scopus, Web of Science, and MEDLINE databases were searched for studies involving VR, pain, and anxiety in patients with breast cancer published up to March 2022. The Cochrane Handbook for Systems quality evaluation standard 6.3.0 was followed to assess risk of bias in the identified studies, with the results reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Subsequently, a meta-analysis of the included data was conducted using RevMan 5.3 software. RESULTS: Six randomized controlled trials and one quasi-experimental study were included. The strength of the evidence ranged from moderate to high. Although VR was found to ameliorate anxiety in patients with breast cancer, only three studies showed statistically significant changes. All of the included studies reported statistically significant improvement in pain levels. In addition, two of the studies reported cybersickness symptoms as a common side effect of VR. CONCLUSIONS: VR has an important role to play in alleviating pain in patients with breast cancer. However, evidence demonstrating VR's importance in alleviating anxiety symptoms in this population is insufficient. Studies conducted with larger sample sizes and high-quality research methodologies will be necessary to clarify this issue. Clinical nurses should address the potential side effects of VR.